The barrister comparison
The NSW Attorney General sets rates for counsel engaged by government. These govern public purchasing, not every private client’s bill. Similarly, the Medicare schedule determines the public contribution, not the cost of delivering every specialist service.4
Unlike a privately retained barrister’s client, an eligible private medical patient receives a public subsidy. Government has a legitimate interest in affordability and a responsibility to fund its contribution adequately. Judging doctors solely against a rebate that government controls conceals half the transaction.
When care depends on time
Paediatrics, psychiatry and geriatrics depend heavily on consultation time. Longer-consultation items exist, but rebates do not increase with every extra minute: qualifying 50-minute and 70-minute psychiatry consultations attract the same scheduled benefit. Consultation-based practices may have little procedural income to offset shortfalls. Calling the resulting gap greed avoids the funding question.11,16
For families unable to obtain timely public care, the choice can be a private gap or a long public wait. Patients pay in money or time. Additional privately funded options are ethically defensible only when everyone can obtain timely, effective essential care.16
Why transparency cannot repair an inadequate rebate
Necessary care often has inelastic demand: patients have limited scope to reduce their need when prices rise. Someone needing a biopsy cannot simply shop as if buying an optional service. Cost sharing can mean hardship or delayed treatment.12
Patients deserve clear fees, rebates, gaps, waiting times and relevant quality information before referral. Transparency can help where alternatives exist; it cannot raise an inadequate rebate or create another local specialist.21,22
The Independent Health and Aged Care Pricing Authority uses cost data to set an annual efficient price for public hospital care. Specialist rebates need a comparable published benchmark, adapted to community practice: time, complexity, overheads and work outside appointments. Commission independent costing; publish how rebates compare; and index them against those costs. Monitor increases to ensure patients benefit. Excessive fees still warrant scrutiny.14
Who is blocking access? When Medicare underprices necessary care, government shifts the shortfall on to patients and practices. Neither can absorb it indefinitely. Affordable access requires public funding that supports the real cost of sustainable care.
